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Individual
JACKI LYNN PETERSON
Active
Individual
JACKI LYNN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004687
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
326460
INTERNAL ID-MOTOR VEHICLE ID
—
05
—
8406985
—
WA
Enumeration date
10/27/2006
Last updated
04/16/2008
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